House File 533 - Introduced
HOUSE FILE 533
BY CAHILL, LEVIN, and
WESSEL-KROESCHELL
A BILL FOR
1 An Act relating to care and choices at the end of life,
2 providing penalties, and including effective date
3 provisions.
4 BE IT ENACTED BY THE GENERAL ASSEMBLY OF THE STATE OF IOWA:
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1 Section 1. NEW SECTION. 142E.1 Findings.
2 1. The state of Iowa has long recognized that mentally
3 capable adult individuals have a fundamental right to determine
4 their own medical treatment options in accordance with their
5 own values, beliefs, or personal preferences.
6 2. It is important that the state of Iowa upholds both the
7 highest standard of medical care and the full range of options
8 for each individual, particularly at the end of life.
9 3. Terminally ill individuals may undergo unremitting
10 pain, agonizing discomfort, and a sudden, continuing, and
11 irreversible reduction in their quality of life at the end of
12 life.
13 4. The availability of medical aid in dying provides
14 an additional palliative care option for terminally ill
15 individuals who seek to retain their autonomy and some level of
16 control over the progression of the terminal disease as they
17 near the end of life or to ease unnecessary pain and suffering.
18 5. Integration of medical aid in dying into standard
19 end-of-life care has demonstrably improved end-of-life care
20 by contributing to better conversations between providers
21 and their patients, earlier and more appropriate enrollment
22 in hospice care, and better palliative care training for
23 providers.
24 6. The state of Iowa seeks to affirm that a provider who
25 respects and honors the values and priorities of individuals
26 with a terminal disease for their last days of life and
27 prescribes or dispenses medication for any such qualified
28 terminally ill individual who makes a request pursuant
29 to this chapter is practicing lawful patient-centered and
30 patient-directed care.
31 7. Patient-directed care differs from patient-centered
32 care in that it is not only respectful of and responsive to
33 individual patient decisions, preferences, needs, and values,
34 but also ensures that patient values direct all clinical
35 decisions and that patients are fully informed of and able to
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1 access legal options they desire.
2 Sec. 2. NEW SECTION. 142E.2 Short title.
3 This chapter shall be known and may be cited as the “Iowa Our
4 Care, Our Options Act”.
5 Sec. 3. NEW SECTION. 142E.3 Definitions.
6 As used in this chapter, unless the context otherwise
7 requires:
8 1. “Adult” means an individual eighteen years of age or
9 older.
10 2. “Attending provider” means the provider who has primary
11 responsibility for the care of a patient and treatment of the
12 patient’s terminal disease.
13 3. “Coercion or undue influence” means the willful attempt,
14 whether by deception, intimidation, or any other means, to do
15 any of the following:
16 a. Cause a patient to request, obtain, or self-administer
17 medication pursuant to this chapter with the intent to cause
18 the death of the patient.
19 b. Prevent a qualified patient from obtaining or
20 self-administration of medication pursuant to this chapter.
21 4. “Consulting provider” means a provider who is qualified
22 by specialty or experience to make a professional diagnosis and
23 prognosis regarding a patient’s disease.
24 5. “Department” means the department of health and human
25 services.
26 6. “Health care entity” means a hospital licensed under
27 chapter 135B, a nursing facility licensed under chapter 135C,
28 an inpatient hospice program, a clinic, or any other facility
29 licensed by the state wherein medical care is provided. “Health
30 care entity” does not include a provider.
31 7. “Informed decision” means a decision by a medically
32 capable requesting patient to request and obtain a prescription
33 for medication pursuant to this chapter that the qualified
34 patient may self-administer to bring about a peaceful death
35 after being fully informed by the attending provider and
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1 consulting provider of all of the following:
2 a. The requesting patient’s diagnosis and prognosis.
3 b. The potential risk associated with taking the medication
4 to be prescribed.
5 c. The probable result of taking the medication to be
6 prescribed.
7 d. The feasible end-of-life care and treatment options for
8 the requesting patient’s terminal disease, including but not
9 limited to comfort care, palliative care, hospice care, and
10 pain control, and the risks and benefits of each.
11 e. The requesting patient’s right to withdraw a request
12 pursuant to this chapter or consent for any other treatment,
13 at any time.
14 8. “Licensed mental health provider” means the same as a
15 “mental health professional” as defined in section 228.1.
16 9. “Medical aid in dying” means the practice of evaluating
17 a patient’s request for medication, determining if a patient
18 is qualified, performing the duties specified, and providing a
19 prescription to a qualified patient, pursuant to this chapter.
20 10. “Medical-aid-in-dying medication” or “medication” means
21 the medication prescribed and dispensed under this chapter to a
22 qualified patient to bring about a peaceful death.
23 11. “Medically confirmed” means the attending provider’s
24 medical opinion that the patient is eligible to receive
25 medication pursuant to this chapter has been confirmed by the
26 consulting provider after performing a medical evaluation.
27 12. “Mentally capable” means that in the opinion of the
28 provider or licensed mental health provider, if an opinion is
29 required under this chapter, the requesting patient has the
30 ability to make and communicate an informed decision.
31 13. “Oral request” means an affirmative statement that
32 demonstrates a contemporaneous affirmatively stated desire by
33 the requesting patient seeking medical aid in dying.
34 14. “Patient” means an adult who is under the care of a
35 provider.
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1 15. “Prognosis of six months or less” means the terminal
2 disease of a patient will, within reasonable medical judgment,
3 result in the patient’s death within six months.
4 16. a. “Provider” means a person licensed, certified, or
5 otherwise authorized or permitted by the law of this state
6 to diagnose and treat medical conditions, and prescribe
7 and dispense medication, including controlled substances.
8 “Provider” includes all of the following:
9 (1) A physician licensed to practice medicine pursuant to
10 chapter 148.
11 (2) An advanced registered nurse practitioner licensed
12 under chapter 152 or an advanced practice registered nurse
13 under chapter 152E.
14 (3) A physician assistant licensed under chapter 148C.
15 b. “Provider” does not include a health care entity.
16 17. “Qualified patient” means a mentally capable patient
17 who has satisfied the requirements of this chapter in order
18 to obtain a prescription for medication to bring about a
19 peaceful death. A person shall not be considered a “qualified
20 patient” under this chapter solely because of advanced age or
21 disability.
22 18. “Requesting patient” means a patient with a terminal
23 disease.
24 19. “Self-administer” or “self-administration” means a
25 qualified patient’s performance of an affirmative, conscious,
26 voluntary act to ingest medication prescribed pursuant to
27 this chapter to bring about the qualified patient’s peaceful
28 death. “Self-administration” does not include administration by
29 parenteral injection or infusion.
30 20. “Terminal disease” means an incurable and irreversible
31 disease that has been medically confirmed and will, within
32 reasonable medical judgment, produce death within six months.
33 Sec. 4. NEW SECTION. 142E.4 Informed consent.
34 1. This chapter shall not be construed to limit the amount
35 of information provided to a patient to ensure the patient can
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1 make an informed decision.
2 2. An attending provider shall provide sufficient
3 information to a patient regarding all appropriate end-of-life
4 care options, including hospice and palliative care, and the
5 foreseeable risks and benefits of each, so that the patient
6 can make a voluntary and affirmative decision regarding the
7 patient’s end-of-life care.
8 3. An attending provider is deemed to fail to obtain
9 informed consent for subsequent medical treatment if a
10 requesting patient requests information about medical aid in
11 dying and, within a reasonable time, the provider has failed,
12 at a minimum, to do either of the following:
13 a. Provide information to the requesting patient about
14 medical aid in dying and other legal end-of-life options.
15 b. Document the date of the requesting patient’s request
16 in the patient’s medical record and upon request transfer the
17 requesting patient’s medical records to an alternative provider
18 consistent with federal and state law.
19 4. If a requesting patient requests that the requesting
20 patient’s medical records be transferred to an alternative
21 provider, the requesting patient’s medical records shall be
22 transferred within two business days.
23 Sec. 5. NEW SECTION. 142E.5 Standard of care.
24 1. Care that complies with this chapter shall be deemed to
25 meet the medical standard of care.
26 2. This chapter shall not be construed to exempt a provider
27 or other medical personnel from meeting medical standards of
28 care for a patient’s treatment.
29 Sec. 6. NEW SECTION. 142E.6 Request for medical aid in
30 dying.
31 1. A mentally capable patient with a terminal disease may
32 request a prescription for medication under this chapter. The
33 requesting patient shall make an oral request and a written
34 request and shall reiterate the oral request to the requesting
35 patient’s attending provider no less than forty-eight hours
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1 after making the initial oral request. An oral request charted
2 in the requesting patient’s medical record by a provider other
3 than the requesting patient’s attending provider satisfies the
4 oral request requirement under this section.
5 2. The attending and consulting providers of a qualified
6 patient shall meet all requirements of sections 142E.8 and
7 142E.9.
8 3. Notwithstanding any provision to the contrary under
9 subsection 1, if the requesting patient’s attending provider
10 has determined that the requesting patient will, based on
11 reasonable medical judgment, die within forty-eight hours
12 after making the initial oral request under this section,
13 the requesting patient may satisfy the requirements under
14 this section by reiterating the oral request to the attending
15 provider at any time after making the initial oral request.
16 4. At the time the requesting patient makes the second oral
17 request, the attending provider shall offer the requesting
18 patient an opportunity to rescind the request.
19 5. Oral and written requests for the requesting patient must
20 be made only by the requesting patient and shall not be made
21 by the requesting patient’s surrogate decision-maker, health
22 care proxy, attorney-in-fact for health care, or via an advance
23 health care directive.
24 6. If a requesting patient decides to transfer the
25 requesting patient’s care to an alternative provider, the
26 custodian of the requesting patient’s medical records shall
27 transfer all relevant medical records including written
28 documentation of the dates of any of the requesting patient’s
29 oral or written requests concerning medical aid in dying within
30 two business days.
31 7. The transfer of care or medical records of a requesting
32 patient does not toll or restart any waiting period under this
33 section.
34 Sec. 7. NEW SECTION. 142E.7 Form of written request ——
35 requirements.
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1 1. A written request for medication under this chapter shall
2 be in substantially the following form, signed and dated by
3 the requesting patient, and witnessed by at least one person
4 who, in the presence of the requesting patient, attests that to
5 the best of the witness’s knowledge and belief the requesting
6 patient is mentally capable, acting voluntarily, and is not
7 being coerced nor unduly influenced to sign the request.
8 Request for Medication
9 to End My Life in
10 a Peaceful Manner
11 I, ___________________________________ am an adult of sound
12 mind. I have been diagnosed with
13 _______________________________________________, and given a
14 prognosis of six months or less to live.
15 I have been fully informed of the feasible alternatives,
16 and the concurrent or additional treatment opportunities for
17 my terminal disease, including but not limited to comfort
18 care, palliative care, hospice care, or pain control, and the
19 potential risks and benefits of each. I have been offered or
20 received resources or referrals to pursue these alternative,
21 or concurrent or additional treatment opportunities for my
22 terminal disease.
23 I have been fully informed of the nature of the medication to
24 be prescribed, including the risks and benefits, and understand
25 that the likely outcome of self-administration of medication
26 is death. I understand that I can rescind this request at any
27 time, that I am under no obligation to fill the prescription
28 once written nor to self-administer the medication if I obtain
29 the medication.
30 I request that my attending provider furnish a prescription
31 for medication that will end my life if I choose to
32 self-administer it, and I authorize my attending provider to
33 contact a pharmacist to dispense the prescription at a time of
34 my choosing.
35 I make this request voluntarily, free from coercion or undue
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1 influence.
2 ________________________________________ _____________
3 Requesting Patient Signature Date
4 ________________________________________ _____________
5 Witness Signature Date
6 2. The witness required under this section shall not be any
7 of the following:
8 a. A relative of the requesting patient by blood, marriage,
9 or adoption.
10 b. A person who at the time the request is signed would be
11 entitled to any portion of the estate of the requesting patient
12 upon death, under any will or by operation of law.
13 c. An owner, operator, or employee of a health care entity
14 where the requesting patient is receiving medical treatment or
15 is a resident.
16 d. The requesting patient’s attending provider at the time
17 the request is signed.
18 e. An interpreter for the requesting patient, if the
19 requesting patient uses an interpreter.
20 Sec. 8. NEW SECTION. 142E.8 Attending provider
21 responsibilities.
22 The attending provider shall do all of the following:
23 1. Determine whether a requesting patient has a terminal
24 disease with a prognosis of six months or less and is mentally
25 capable.
26 2. Confirm that the requesting patient’s request does not
27 arise from coercion or undue influence.
28 3. Inform the requesting patient of all of the following:
29 a. The requesting patient’s diagnosis and prognosis.
30 b. The potential risks, benefits, and probable result of
31 self-administration of the prescribed medication to bring about
32 a peaceful death.
33 c. The potential benefits and risks of feasible alternatives
34 including but not limited to concurrent or additional treatment
35 options for the requesting patient’s terminal disease,
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1 palliative care, comfort care, hospice care, and pain control.
2 d. The requesting